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The association between symptoms of depression and office visits in patients with nontraumatic upper-extremity illness. Crijns, T., Bernstein, D., Teunis, T., Gonzalez, R., Wilbur, D., Ring, D., & Hammert, W. Level of Evidence : 2b Follow recommendation : 👍 👍 👍 Type of study : Symptoms prevalence study Topic : Trigger finger, carpal tunnel syndrome, benign lumps, hand osteoarthritis, and de Quervain tendinopathy association with depression - Mental health and number of outpatient visits This retrospective study assessed the association between the number of visits to an outpatient hand surgeons' clinic and levels of pain and depression. The patients presented with several different conditions including trigger finger (30%), carpal tunnel syndrome (27%), benign lumps (20%), hand osteoarthritis (13%), and de Quervain tendinopathy (9%). The results showed that people with greater depressive symptoms or pain attended the clinic for an additional 2 appointments compared to the rest of the sample. Unfortunately, due to the study design, we cannot comment on whether higher levels of depression/pain lead to greater disease severity and therefore higher number of visit or vice versa. Clinical Take Home Message : Hand therapists could support patients with depression by providing information about free help lines . In addition, a referral to the GP or psychologist could be useful to initiate treatment for this condition. It is also possible that improvements in hand condition will lead to reduction in symptoms of depression. Further research will need to clarify this last point. URL : https://www.jhandsurg.org/article/S0363-5023(18)30704-4/abstract

Synovial hemangioma of the wrist with cystic invasion of trapezoid and capitate bones Zhao, X., Qi, C., Chen, J., Li, H., Zhang, Y., & Yu, T. Level of Evidence : 5 Follow recommendation : 👍 Type of study : Diagnostic/Therapeutic Incidence : Rare Topic : Synovial Haemangioma - Diagnosis and treatment This is the answer for the case study from last week. The patient was an 18 year old male who had been experiencing pain and swelling in the back of the wrist in the last 2 years. Objectively, there was a 3x3 cm non-pulsatile mass in the back of the wrist. Extension range of movement had a deficit of 20 degrees. X-ray was impeccable, however, computer tomography and MRI scans revealed an ill-defined soft tissue mass between scaphoid, trapezoid, and capitate. Following surgery, it was possible to make a diagnosis of wrist synovial haemangioma. Synovial haemangiomas are rare benign tumours which usually affect children or young adults. Only 300 cases have been reported in the literature, most of which occurred in the knee. Symptoms vary and intermittent pain may be present or absent. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Hand therapists should refer young children or teenagers for x-rays and ultrasound when there is evidence of an irregularly shaped, soft mass which appears to or is reported to have grown over time. The likelihood of identifying a synovial haemangioma is extremely rare, however, this work up would help differentiating among different conditions including ganglion cyst, rheumatoid arthritis, haematomas associated with haemophilia, infections or other rare forms of cancer. URL : https://www.jhandsurg.org/article/S0363-5023(18)30316-2/fulltext Available through The Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract Synovial hemangiomas (SHs) are rare lesions of the joints or tendon sheaths that are difficult to diagnose. We present the case of an 18-year-old man with an SH in the wrist joint. Physical examination revealed a slightly tender, ill-defined, nonpulsatile soft mass, 3 cm × 3 cm in size on the dorsal aspect of the left wrist. Computed tomography showed an irregular, ill-defined, soft tissue mass in the expanded joint space, which was formed by the scaphoid, trapezoid, and capitate bones. Magnetic resonance imaging showed the typical features of SH and also revealed cavitary erosion of the scaphoid, trapezoid, and capitate bones. An open arthrotomy was performed via a dorsal approach, and the mass was excised. The histological examination findings were consistent with the diagnosis of SH.

The relationship of mental health status to functional outcome and satisfaction after carpal tunnel release Maempel, J., Jenkins, P., & McEachan, J. Level of Evidence : 4 Follow recommendation : 👍 👍 👍 Type of study : Prognostic Topic : Carpal tunnel syndrome (CT) and mental health - Outcomes before and after surgical intervention This is a prospective cohort study assessing the relationship between mental health and outcomes following surgery for CT. The results are to be considered in the context of a few limitations. Of the entire cohort, only 52% of the participants returned the Short Form-12 (SF-12), used to assess mental health. In addition, SF-12 scores were only collected at one-year post surgery, which defeats the point of a prospective cohort study. The results show a correlation between mental health status and patient reported satisfaction at one year after surgery. There was also a statistically, but not clinically significant difference in QuickDASH scores of patients presenting with mental health problems compared to healthy patients at one year follow up. This correlation might be due to worse mental health state leading to lower function or vice versa. It is also possible that a third unknown variable, not measured in the present study, mediated this association. Clinical Take Home Message : Hand therapists should keep in mind that functional recovery of patients undergoing surgery for CT may be worse if they present with poorer mental health. A multidisciplinary approach to treatment and rehabilitation may be effective in improving functional outcomes. URL : https://journals.sagepub.com/doi/full/10.1177/1753193419866400

Short functional dynamic orthosis for proximal interphalangeal joint extension deficit. Crest design Cantero-Téllez, R. Level of Evidence : 5 Follow recommendation : 👍 Type of study : Therapeutic Topic : Proximal interphalangeal joint (pipj) extension lag treatment - Dynamic orthosis. This practice forum presented step by step instructions on how to create a dynamic splint for pipj extensor lag. It is advised to wear the splint 6 hours daily in combination to a static night splint for 6/52. The orthosis is reported to be a useful alternative in settings where off the shelf products are not available. A piece of 1.6 to 2mm thermoplastic, orficast, and elastic bands are required. A small cylinder for the proximal phalanx is created and connected to the distal cylinder which includes the proximal and distal phalanx. The pipj is therefore left free to move. The two cylinders are connected on radial and ulnar side by two orficast stripes to warrant stability of the splint. Two hooks are positioned on the dorsal proximal cylinder and at the dorsal distal cylinder at dipj level. An elastic band is attached to the two hooks to assist with pipj extension and allow pipj flexion. Clinical Take Home Message : Hand therapists should make sure that the extension lag at the pipj is not due to a central slip before deciding to apply this splint. If no central splip is suspected, the clinician may consider this new design as an alternative to existing splints. If available, however, an off the shelf LMB finger extension splint would probably achieve the same result. In a low resource setting, a relative motion flexion splint may be a suitable alternative to this new design. URL : https://www.jhandtherapy.org/article/S0894-1130(18)30148-0/fulltext